DOMS EARLY REINTERVENTION (ERI) EXPERIMENT

DOMS 早期再干预 (ERI) 实验

• 批准号: 6378714
• 负责人: MICHAEL L DENNIS
• 金额: $ 54.07万
• 依托单位: CHESTNUT HEALTH SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-08-01 至 2003-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6378714
• 关键词: behavior therapy; clinical research; drug abuse prevention; drug abuse therapy; health care service utilization; human subject; human therapy evaluation; interview; motivation; outcomes research; patient care management; relapse /recurrence; social support network; substance abuse related behavior

While most clinicians view substance use as a chronic relapsing condition that may require multiple episodes of care, most research to date has focused on single episodes of care. Recent emphasis on outcome based contracts and/or capitated cost contracts has stimulated interest in better managing clients "across" multiple admissions and/or in a continuum of care model. In the treatment of other chronic illnesses quarterly, semi-annual or annual check-ups are often integral parts of aftercare which check for early indications of relapse and attempt early re-intervention before the condition and consequences worsen. The specific aims of this study are to determine the relative effectiveness of an Early Re-Intervention (ERI) protocol in terms of its ability to: 1) reduce the time to treatment re-entry and increase the rates of early treatment re-entry, and, 2) improve long-term outcomes related to a) substance use, HIV risk behaviors, illegal activity, b) training- and employment-related behaviors, and c) utilization of expensive services (e.g., inpatient substance abuse treatment, inpatient mental health treatment, emergency room admissions, hospital nights, days in jail, days of their children being in foster care or institutions). To evaluate ERI, 800 new clients with substance use disorders will be recruited from two central intake units, one located in Chicago and another in Central Illinois. Clients will be blocked into one of five severity groups (based on drug dependence, alcohol dependence, and frequency of use) then randomly assigned to either quarterly outcome monitoring (OM) with 20-30 minute assessments for 18 months or quarterly OM plus ERI. Response of participants in the ERI condition will be used to determine the participants linkage assistance needs every quarter. ERI Linkage Managers will provide the qualified participants with linkage assistance including feedback on their current substance use and need for treatment, motivational discussions to convince them to consider returning to treatment, and then direct assistance in helping them make and keep a readmission appointment. Through feedback, social reinforcement, and assistance to access care, ERI is expected to reduce the time to readmission, increase the rate of early treatment re-admissions, and consequently, improve long-term outcomes. Significant findings in favor of the ERI protocol would provide a better understanding of the clinical value of outcome monitoring and a straightforward, replicable protocol for improving the long-term effectiveness of drug treatment.

尽管大多数临床医生将使用物质使用视为可能需要多个护理的慢性复发状况，但迄今为止，大多数研究都集中在单个护理上。 最近强调基于结果的合同和/或承受的成本合同，激发了人们对更好地管理客户的兴趣”，“在“多次入学”和/或连续的护理模型中。在季度治疗其他慢性疾病的过程中，半年度或年度检查通常是护理的组成部分，该部分检查是否会在病情和后果恶化之前早期复发并尝试早期重新干预。 The specific aims of this study are to determine the relative effectiveness of an Early Re-Intervention (ERI) protocol in terms of its ability to: 1) reduce the time to treatment re-entry and increase the rates of early treatment re-entry, and, 2) improve long-term outcomes related to a) substance use, HIV risk behaviors, illegal activity, b) training- and employment-related behaviors, and c) utilization of expensive services (e.g.,住院药物滥用治疗，住院心理健康治疗，急诊室入院，住院之夜，入狱日期，孩子在寄养或机构中的日子）。为了评估ERI，将从两个中央进气单元，一个位于芝加哥，另一个位于伊利诺伊州中部，将招募800名具有药物使用障碍的新客户。 然后将客户封锁为五个严重性组之一（基于药物依赖，酒精依赖和使用频率），然后随机分配给季度结果监测（OM），并在18个月内进行20-30分钟的评估或季度OM加ERI。 在ERI条件下的参与者的响应将用于确定每个季度的参与者链接援助需求。 ERI Linkage经理将为合格的参与者提供连锁协助，包括有关他们当前的物质使用和治疗需求的反馈，激励性讨论说服他们考虑重返治疗，然后直接帮助他们进行和保持再入院任命。 通过反馈，社会加强和辅助访问护理，ERI有望减少再入院的时间，提高早期治疗率的速度，从而改善长期结局。有利于ERI方案的重大发现将更好地理解结果监测的临床价值以及一种直接，可复制的方案，以提高药物治疗的长期有效性。